Beyond Skin Clearance: Personalized Strategies for DLQI Improvement in Psoriasis -Insights From a Shanghai Prospective Cohort.

Introduction: Psoriasis is a chronic immune-mediated disease that significantly impacts patients clinically and psychologically. Physician-assessed severity measures, including Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Physician Global Assessment (PGA), often fail to capture patient-reported outcomes, particularly when clinical improvement and perceived quality-of-life gains are misaligned. Purpose: To clarify the association between clinical improvements and Dermatology Life Quality Index (DLQI) outcomes, identify predictors of substantial DLQI improvement (≥90% reduction), and explore reasons for suboptimal DLQI responses in patients achieving skin clearance. Methods: In this 12-week prospective study, 551 psoriasis patients were enrolled at Shanghai Skin Diseases Hospital. Data on demographics, clinical severity (PASI, BSA, and PGA), DLQI scores, and treatment modalities were collected. Logistic regression analyses were employed to assess the dose-response relationships between improvements in clinical parameters and DLQI reduction, and to identify factors of suboptimal DLQI improvement among patients achieving significant skin clearance. Results: Median DLQI improved significantly (8.0 to 3.0) at week 12, with 24.1% of patients achieving ≥90% DLQI reduction. Strong dose-response associations existed between clinical severity improvements (PASI, BSA, PGA) and DLQI gains. PASI Conclusion: Early clinical response effectively predicts substantial DLQI improvement, whereas demographic and disease-related factors help identify patients at risk for suboptimal quality-of-life gains despite significant skin clearance. These insights support personalized therapeutic strategies aimed at improving patient satisfaction beyond skin clearance alone.